Influences of Preparedness Knowledge and Beliefs on Household Disaster Preparedness

Tracy N. Thomas, MSc1; Michelle Leander-Griffith, MPH1; Victoria Harp1; Joan P. Cioffi, PhD1

In response to concern about strengthening the nation's ability to protect its population and way of life (i.e., security) and ability to adapt and recover from emergencies (i.e., resilience), the President of the United States issued Presidential Policy Directive 8: National Preparedness (PPD-8) (1). Signed on March 30, 2011, PPD-8 is a directive for the U.S. Department of Homeland Security to coordinate a comprehensive campaign across government, private and nonprofit sectors, and individuals to build and sustain national preparedness. Despite efforts by the Federal Emergency Management Agency (FEMA) and other organizations to educate U.S. residents on becoming prepared, growth in specific preparedness behaviors, including actions taken in advance of a disaster to be better prepared to respond to and recover, has been limited (2). In 2012, only 52% of U.S. residents surveyed by FEMA reported having supplies for a disaster (2), a decline from 57% who reported having such supplies in 2009 (3). It is believed that knowledge influences behavior, and that attitudes and beliefs, which are correlated with knowledge, might also influence behavior (4). To determine the association between knowledge and beliefs and household preparedness, CDC analyzed baseline data from Ready CDC, a personal disaster preparedness intervention piloted among Atlanta- and Morgantown-based CDC staff members during 2013–2015. Compared with persons with basic preparedness knowledge, persons with advanced knowledge were more likely to have assembled an emergency kit (44% versus 17%), developed a written household disaster plan (9% versus 4%), and received county emergency alert notifications (63% versus 41%). Similarly, differences in household preparedness behaviors were correlated with beliefs about preparedness. Persons identified as having strong beliefs in the effectiveness of disaster preparedness engaged in preparedness behaviors at levels 7%–30% higher than those with weaker preparedness beliefs. Understanding the influences of knowledge and beliefs on household disaster preparedness might provide an opportunity to inform messages promoting household preparedness.

In 2013, CDC partnered with the American Red Cross and state and local Georgia emergency management agencies to develop and pilot Ready CDC among CDC staff members living in metropolitan Atlanta. Co-branded with FEMA's Ready campaign, the program consisted of a pre-assessment of household preparedness behaviors, a 1-hour in-person workshop with local experts, a workshop evaluation, receipt of three behavioral reinforcement messages, and a post-assessment evaluation 3 months after the workshop. Eleven Ready CDC recruitment campaigns were held from September 2013 through June 2015. All participants provided informed consent and completed a pre-assessment survey before enrollment. Approval of data collection activities was granted by CDC's institutional review board (Protocol #6472). This analysis includes data from the pre-assessment only.

The pre-assessment survey collected information about respondent demographics, disaster deployment experience, and several household preparedness indicators, including possession of emergency kit items, existence of a written household disaster plan, and community planning characteristics. To assess the association of knowledge with preparedness, pre-assessment respondents were dichotomized based on their level of knowledge. Participants who reported they were aware of the need to assemble an emergency kit, the need to develop a written household disaster plan, that disasters were likely to occur in their county of residence, the meaning of outdoor warning sirens, and where to sign up for free cardiopulmonary resuscitation (CPR) and first aid training were categorized as having advanced knowledge. Participants who did not meet all the criteria for having advanced knowledge were classified as having basic knowledge.

To assess the influence of beliefs on preparedness behavior, three belief domains were constructed: risk perception, preparedness, and self-efficacy. A seven-point Likert scale was used to assess level of participant agreement with beliefs about risk perception (belief that participant was at risk for experiencing a disaster and that a potential disaster was likely serious); preparedness (belief that assembling a kit and/or having a written disaster plan would mitigate the harmful effects of a disaster); and self-efficacy (perceived ability to easily assemble a kit and/or develop a written disaster plan). Participants reporting that they "somewhat agree," "agree," or "strongly agree" were categorized as having strong beliefs for the respective belief domains; all others were categorized as having weak beliefs.

Household preparedness measures assessed included possession or maintenance of an assembled emergency kit and written emergency plan, defined based on the Transtheoretical Model of Behavior Theory stage of change (5), possession of 16 recommended kit items, and having practiced the written plan (6). Community planning preparedness behaviors, such as receipt of emergency alert notifications from the county, encouraging friends and neighbors to be personally prepared, and having someone in the home trained in CPR and first aid were also assessed. High adoption of household preparedness was defined as reported adoption of ≥11 of 21 preparedness measures (having 16 emergency kit items, having a written emergency household plan, and participating in the four community preparedness behaviors).

Reported preparedness behaviors were analyzed according to knowledge and belief levels. Estimates were adjusted for demographics that differed significantly in Chi-square tests across categories of knowledge and beliefs, including sex, disaster deployment experience (field or emergency operations center deployment or participation in emergency response exercise versus none), age (<45 and ≥45 years), education (college degree or less versus postgraduate education) and having adults >65 years living at home.

Logistic regression was used to identify factors associated with high household preparedness adoption, including, demographics, knowledge, risk perception beliefs, personal or awareness of friends' experiences with a disaster, and social connectedness. Factors significantly associated with high adoption by univariate analysis were entered into a step-wise multivariate model to determine the final model. Odds ratios and corresponding 95% confidence intervals were reported where applicable.

A total of 439 (10.0%) of 4,402 CDC staff members invited to one of the 11 Ready CDC sessions enrolled and completed the pre-assessment. The majority of participants were aged ≥45 years (63%), female (64%), part of an unmarried or married couple (73%), had a master's degree or higher (67%), owned their home (85%), and had no disaster deployment experience (54%). Overall, 123 (28%) participants had advanced preparedness knowledge. Significant differences in reported preparedness behaviors were observed between knowledge levels (Table 1). The largest differences related to emergency kit items between those with advanced and basic knowledge were possession of a multipurpose tool (83% versus 58%), an emergency blanket (67% versus 42%), and a first aid kit (84% versus 59%) (p<0.001). In terms of community planning preparedness behaviors, 65% of participants with advanced knowledge reported encouraging others to be personally prepared, compared with 40% of participants with basic knowledge (p<0.001).

The correlation of beliefs with personal preparedness behaviors varied across the three belief domains (Table 2). Risk perception beliefs were associated with having a kit, with 30% of those having strong beliefs reporting having a kit, compared with 21% of those with weak risk perception beliefs (p = 0.041). However, risk perception beliefs were not associated with having a written emergency plan or engaging in community planning preparedness. Preparedness and self-efficacy beliefs were associated with both emergency kit and written plan preparedness. Participants who strongly believed having a kit and plan would mitigate the effects of a disaster (i.e., strong preparedness belief) were more likely to report having a kit or plan. Among participants with strong preparedness beliefs, 26% possessed an emergency kit, compared with 14% of participants with weak preparedness beliefs (p = 0.048). Among participants with strong self-efficacy beliefs, 29% possessed an emergency kit, compared with only 8% of participants with weak self-efficacy beliefs (p = 0.001). Significant differences in the proportion of participants reporting possession of specific kit items were observed by strength of self-efficacy beliefs, but not preparedness beliefs. The greatest reported differences in reported possession of emergency kit items between participants with strong and weak self-efficacy beliefs were a 3-day food supply (59% versus 29% [p<0.001]) and a 3-day water supply (46% versus 18% [p = 0.001]).

Demographic characteristics associated with household preparedness adoption included age and sex. (Table 3). Additionally, participants reporting preparedness knowledge and social connectedness (i.e., neighbors willing to help in the community) were more likely identified as high adopters of household preparedness.

Discussion

Among Ready CDC participants representing the metropolitan Atlanta CDC workforce, household preparedness was associated with preparedness knowledge and beliefs. Findings were consistent with studies that found that exposure to a greater number of preparedness information sources was positively associated with having a household plan (7) and that persons who were exposed to more emergency-related news in the media were more likely to have emergency preparedness items and engage in a higher stage of preparation actions than persons with lower exposure to emergency-related news (8). Additionally, these findings were consistent with those of a study that examined beliefs about earthquake hazards and household preparedness, which reported that beliefs related to threat inevitability, preparedness effectiveness, and self-efficacy influence adoption of preparedness behaviors (9).

Differences in possession of specific emergency kit items by knowledge level might reflect items that are more commonly referenced in disaster-related messaging. For example, persons with advanced preparedness knowledge were more aware than those with basic preparedness knowledge of items such as emergency blankets and first-aid kits; whereas both groups were aware of items that are referenced in everyday messaging, such as medications and flashlights. The lack of correlation between risk perception beliefs and certain household preparedness behaviors — specifically having a written emergency plan and engaging in community preparedness — might be explained by findings from other studies that suggest even if an person perceives a risk, that perception might not lead to preparedness behaviors, particularly if the risk is not perceived to be imminent (8,9). Correlation of preparedness beliefs with possession or maintenance of an emergency kit, but not specific kit items, might be attributable to lack of knowledge of items recommended in an emergency kit. The correlation of self-efficacy beliefs with preparedness behavior is consistent with findings in a study that suggested that persons who believed they could prepare and respond were more likely to adopt those behaviors, and that preparedness is stronger when undertaking simple tasks, but wanes as tasks become more complex (9). Thus, potential barriers such as cost and lack of storage space might add to the complexity of gathering and storing certain items, and thereby explain the most notable differences in possession of 3-day water and food supplies among those with strong versus less strong self-efficacy beliefs.

This study identified demographic and social connectedness characteristics as correlates of household preparedness adoption. In this study, men were more likely to report personal preparedness than women. A 2009 personal preparedness survey conducted by FEMA suggested that education and income are correlated with preparedness behaviors (3). A previous study found that the belief that an individual has some responsibility to take care of others is correlated with preparedness behaviors (9). Further research regarding the sociodemographic determinants of household preparedness is warranted.

The findings in this report are subject to at least four limitations. First, survey data are self-reported and might not reflect actual levels of emergency preparedness behaviors. Second, participants were dichotomized into subjective categories. Third, this population of public health employees was a convenience sample with a low enrollment rate, and thus might not be representative or generalizable. Finally, reported knowledge, beliefs, and preparedness behavior measures might have been biased toward responses deemed more socially desirable among a population of public health employees.

Risk communication messaging and strategies designed to encourage household preparedness behaviors should incorporate approaches that will lead to higher levels of preparedness knowledge. Additionally, understanding the influences of beliefs on personal preparedness and promoting beliefs that encourage preparedness behaviors might improve risk communication and campaigns designed to encourage household preparedness. Education, training, and messaging aimed at changing behaviors need to address beliefs that are more likely to impact preparedness behaviors. Messaging that focuses on preparedness tasks that are simple and incorporates evidence-based findings into household disaster preparedness behaviors might improve community disaster response, mitigation, and recovery.

Acknowledgments

Lisa Janak Newman, Georgia Emergency Management Agency; Ryan Logan, American Red Cross Southeast Region; Nancy Coltrin, Gwinnett Emergency Management Agency; Robert Swanson, DeKalb County Emergency Management Agency; Matthew Kallmyer, MPH, Atlanta-Fulton County Emergency Management Agency; Teresa Guzman, Dave Giraitis, MBA, MA, Leidos, Atlanta, Georgia; Robyn Sobelson, PhD, Corinne Wigington, MPH, Office of State, Tribal, Local, and Territorial Support, CDC; Alyson Davis, MPH, Alexandra Sowers, MPH, Office of Public Health Preparedness and Response, CDC; Richard Klomp, MOB, MS, Jonathan Trapp, MPA, Office of Safety, Security, and Asset Management, CDC.

1Learning Office, Office of Public Health Preparedness and Response, CDC.

Corresponding author: Tracy N. Thomas, tct5@cdc.gov, 404-639-5980.

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